417 Aquatic Dr PLRS24-0173 Applicationmfr. Plumbing Permit Application
City of Atlantic Beach Building Department
800 Seminole Rd, Atlantic Beach, FL 32233
Phone: (904) 247-5826 Email: Building-Dept@coala.us
"ALL INFORMATION
HIGHLIGHTER IN
GRAY IS REQUIRED.
PERMIT #:
JOB ADDRESS: 417 Aquatic Chive Atlantic Beach EL 32233 PROJECT VALUE $18
[IN EW OR REPLACEMENT INSTALLATION and/or [I RE -PIPE
TYPE OF FIXTURE
Bathtub
Clothes Washer
Dishwasher
Drinking Fountain
Floor Drain
Floor Sink
Hose Bibs
Kitchen Sink
Laundry Tray
Lavatory
Other Fixtures
❑MISCELLANEOUS
QTY TYPE OF FIXTURE QTY
Septic Tank & Pit
Shower
Shower Pan
Slop Sink
Three Compartment Sink
Toilet
Urinal
Vacuum Breakers
Water Connected Appliances
Water Heater
Water Treating System
Sewer Replacement
Back Flow Preventer
Li Lawn Sprinkler System (number of sprinkler heads)
Grease Interceptor (Trap) gallons (Requires 1 set of digital plans)
Well ** SJRWD Well Completion Form. Completed form to be submitted to the Building Department for final inspection. **
Other
Permit becomes void if work does not commence within a six month period or work is suspended or abandoned for six months.
I hereby certify that I have read this application and know the same to be true and correct. All provisions of laws and ordinances
governing this work will be complied with whether specified or not. The permit does not give authority to violate the provisions
of any other state or local law regulation construction or the performance of construction.
Owner Name: Ny � i ea LL -C— __ _ --Phone Number: _
Plumbing Company:_Js�__Lt�1C�-'SSio1inS PI UMtji� _ Office Phone: q( -�S-03 W Fax
Co. Address: TO -51 RDc>ok ok._ ��_ �� City: aa� C1vi i� State: IFL zip: 3Z?!5'j_
License Holder:
Notarized Signature of License Holder
The foregoing instrument was acknow
County of aVya —
SARACARN:HH
MY COMMSSION # 528298EXPIRES: May 1028
State Certification/Registration # CFCI HZq L4
before me this Z ay of 2044 in the State of Florida,
Signature of Notary Publ
[ ] Personally Known OR [ ] Produced Identification
Type of Identification:
Updated 10/11/23